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Isis Fernanda Vazquez, Jose A Paczka, Sara Aurora Garcia y Otero Sánchez, Andrea Orozco Garcia; Micropulsed Cyclophotocoagulation in Pediatric Patients with Refractory Glaucoma. Invest. Ophthalmol. Vis. Sci. 2020;61(7):5229.
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© ARVO (1962-2015); The Authors (2016-present)
Due to the difficult management of pediatric glaucomas with medical therapy, the primary treatment approach that has to be considered is surgical. A feasible surgical option is the micropulse transscleral cyclophotocoagulation (MP-TSCPC) although very scarce information is present regarding results with this relatively new treatment on pediatric glaucoma patients. The aim of this study is to investigate the short-term efficacy and safety of MP-TSCPC on a consecutive case series of children affected with refractory glaucoma.
A retrospective review of consecutive case series of patients younger than 17 years of age with refractory glaucoma which underwent MP-TSCPC in a specialized center in Western Mexico. All consecutive cases with complete clinical information during at least 6 months of follow-up were included. A surgical procedure success was defined if the following standard criteria were met: (1) the postoperative IOP remained in a range of 5-21 mm Hg and was reduced at least 30% compared to the baseline IOP with or without medication (complete or qualified success), (2) there was no loss of light perception or vision-threatening severe complications, and (3) no additional glaucoma surgery was required. Minor and major complications as well as their outcomes were also registered.
Fourteen eyes of 10 children (mean age, 9.5 ± 4.9 years; 6 female, 4 male) were included in the study. Mean power and time of MP-TSCPC were 2,500 ± 219.26 mW or 122.96 ± 10.77 J, and 157.14 ± 31.23 seconds, respectively. Preoperatively, the mean intraocular pressure (IOP) was 31.93 ± 6.37 mm Hg. Postoperatively, the mean IOP significantly decreased at all follow-up points: 22.42 ± 6.56 mm Hg at 1 day (P=0.0006), 15.71 ± 6.2 mm Hg at 7 days (P<0.0001), 12.94 ± 7.13 mm Hg at 1 month (P<0.0001), 15.84 ± 5.75 mm Hg at 3 months (P<0.0001), and 17.43 ± 6.21 mm Hg (P<0.0001) at 6 months. No significant complications were noted. The success rate was 85.7% at 6 months. One out of 14 cases required reoperation during the 6 months of follow-up.
The reported clinical efficacy and safety of PC-TSCPC to treat refractory glaucomas in the current case series of children is promising but long-term studies are warranted. Laser energy parameters have to be assessed in order to identify pertinent treatment regimes related to disease severity.
This is a 2020 ARVO Annual Meeting abstract.
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